Botulinum Toxin Injections

Botulinum Toxin is injected under the skin causing the facial muscles to relax. While these injections can be effective for Hemifacial Spasm, the effect is temporary and typically lasts 3 to 6 months. Complications can include temporary lid drooping and minor bruising at the injection sites.

Surgery

Before surgery

Side view

Treatment Step 1

Treatment Step 2

After surgery

Microvascular decompression surgery repositions the blood vessel away from the nerve. This is successful in cases of hemifacial spasm where the cause is suspected to be a blood vessel compressing the facial nerve. When medications and injections fail to control spasms, Microvascular Decompression can be a long-term solution to relieving the nerve compression eliminating the spasm. A neurosurgeon makes an opening in the skull (craniotomy) at the back of the head to expose the facial nerve at the brainstem. The surgeon will locate the blood vessel compressing on the nerve and place a special Teflon sponge between the nerve and the blood vessel relieving the pressure and preventing the spasm.

Following the Microvascular Decompression procedure, the neurosurgeon closes the opening and you will be awakened and allowed to recover from anesthesia. Once this pressure has been relieved, patients often report immediate and complete relief from the spasm. Most people stay in the hospital for observation for one to two days.

Video

David Newell, M.D. talks about hemifacial spasm, who it affects, and how it’s treated.

Video Transcript

Hemifacial spasm doesn’t have a specific cause. It may occur as a result of:

Hemifacial spasm is a condition where half of the muscles in the face go into episodic spasms. It often starts in the eye but then progresses to involve the mouth and sometimes even the neck muscles and at the end stages all these muscles on one side of the face undergo rhythmic contractions and can become quite disabling to patients.

It’s not particularly a painful condition but it is very stressful to patients. It often affects adults in middle age and into the advanced years and often affects females a little bit more frequently than males. The cause of hemifacial spasm is a blood vessel in the back of the brain that pulsates with every heartbeat against the nerve and causes the nerve to be hyper-irritable. So any contraction of the face is magnified and involves all the muscles in the face. So what’s thought is that as we age our vessels become elongated and start to form loops and this loop just happens to be located against the facial nerve and causes it to become irritable.

Oral medications have been tried and are usually not effective for hemifacial spasm. The other non-surgical treatment is called botox injections, where botulinum toxin in low doses which interrupts the connections between the nerves and the muscles, is injected in the affected area and that often calms down the spasms for a period of time. It does require the patient get re-injected because the botulinum toxin tends to wear off over time.

The other more definitive treatment is called a microvascular decompression where we make an incision behind the ear and go in with a high powered microscope along the cerebellum, the back of the brain, and find the vessel that is pulsating against the facial nerve and move that aside and then pad it with a teflon sponge or teflon padding. That usually removes any pulsations against the nerve and often is a curative for provides long term relief from the hemifacial spasms. It’s been studied in thousands of patients over a large series of patients have been recorded in the medical literature and it’s usually about ninety percent effective in eliminating the symptoms.

Like any surgery there are risks and patients have to be in good medical condition. Small risks of infections, fluid leak, there’s small risk of hearing loss because the facial nerve and the hearing or the auditory nerve run right together. There’s a very small risk of some facial weakness and some other nerve to the face can be affected, but we do monitoring to try and minimize these and most of the time patients do very well.

After having the surgery the patients are often extremely grateful because it’s such a dramatic effect of having that condition and then all of a sudden they wake up in the recovery room and they have the typical patient has no more spasms after the operation.

At the Neuroscience Institute at Swedish we specialize in somewhat rare conditions like hemifacial spasms and other conditions that have neurosurgical treatments and we do high volumes of these surgeries and we get excellent results because the teams are well trained and the nurses are well trained and the anesthesiologists and monitoring people are very used to taking care of these conditions. We have a routine and protocol for these patients and they tend to do extremely well.

These videos show explanations of hemifacial spasm and its treatment options as well as the steps in performing a microvascular decompression of the 7th cranial nerve on the right to treat hemifacial spasm.

Warning: this video contains graphic depictions of neurosurgery.

[gdlr_heading tag="h6" color="#FFFFFF"]Video: Bilateral Hemifacial Spasm, Before and After Treatment[/gdlr_heading]

It is unusual to see patients with bilateral hemifacial spasm. This video shows before and after video documentation of a bilateral hemifacial spasm, occurring sequentially after several years delay. A microvascular decompression procedure was used to treat the condition on both sides on two separate occasions, with successful results. (video shared with patient permission)

Hemifacial spasm is a neuromuscular disorder that causes frequent involuntary contractions. For help with symptoms, pain, risks, and treatment contact us.
Dr. Newell was born in Boston, MA and attended Case Western Reserve University medical school. He then completed his residency in neurosurgery at the University of Washington, including one year in London at St. George’s medical school. Dr. Newell is the co-founder of the Swedish Neuroscience Institute and founder of the Seattle Neuroscience Institute.

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